Critical Care

It’s 7 a.m. We sit down around a table in the physician's lounge to discuss and our patients. I am a general and critical care surgeon. Every fourth week I’m “on service” for the ICU. This is my week. I was off over the weekend. I’m refreshed and ready to go. I’m excited. I enjoy the challenge of taking care of critically ill patients.
I get sign out from my partner. ...

As the kids say, it’s complicated. Practicing physicians are seeing an ever increasing list of protocols and pathways coming their way. These arrive in several forms -- order sets for medications, guidelines in how to proceed for various conditions, when to do this, when to do that, and when not to do either one. They generally are the product of various committees trying to synthesize what these days we call ...

A lone figure stood at the entrance to bed 14, intensive care unit 2, floor 15-North. Though it was 2:30 a.m., he stood with rapt attention. He looked out over the hallway, eyes scanning. He looked like a gargoyle brooding over his castle, protecting it.
He looked unlike anyone I’d ever seen in an ICU. He was a slightly pudgy yet wholly muscular 5′ 10” or so, with a few days ...

The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for ...

I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today, it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you ...

What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, ...

What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.
Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were ...

Burnout syndrome is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress. I burned out early. Right out of fellowship, I no longer wanted to be a doctor. The grueling hours, my grumpy co-workers, and distant patient engagements left me totally exhausted. However, over the course of a year, I was able to rediscover my passion for medicine.
Some tactics were deliberate, mindful behaviors, some occurred by accident, ...

I burned out early. I was done being a doctor at the end of fellowship. Although I took a job as a critical care physician, I desperately sought to alter my career somehow. I looked into website development, something I had been good at in high school. I took a few refresher classes on my days off and started coding my own sites. Luckily, my first job out of fellowship accepted many ...